Thomas Aldridge

Practices

Rich Albertoni

Manager / Health

Mr. Albertoni leads PCG's policy consulting related to state health insurance exchange planning and implementation. In this role, he has worked with Arkansas, Delaware, Hawaii, Mississippi, Nevada, New Hampshire, and Tennessee. Prior to joining PCG, Mr. Albertoni served in a variety of leadership positions for Wisconsin Medicaid. As Eligibility Director, he led the workgroup that established business requirements for Medicaid and Health Benefits Exchange (Exchange) systems integration. He directed an initiative to establish an online health plan enrollment tool as part of the electronic Medicaid application. And he was a member of the Small Business Health Options (SHOP) implementation group and supervised staff developing Exchange marketing and user engagement tools.

Thomas Aldridge

Manager / Health

Mr. Aldridge has been with PCG for more than 15 years. He currently leads the Payer Services Group within PCG's health division and is focused on efforts to control costs for payers through placement of tighter controls on eligibility and claims processing. Through his leadership, PCG offers to its public and private payer clients solutions such as (1) Health Insurance Exchange Operations, (2) Member Disability Benefit Management, (3) Enhanced Identity and Asset Verification Services, (4) HCBS Independent Assessments and Care Management Programs, (5) Provider Fraud, Waste and Abuse Prevention, Detection, Validation and Recovery and (6) Provider Monitoring and Oversight. Mr. Aldridge currently leads large scale initiatives for North Carolina, Massachusetts, New Mexico, Maine and the United Auto Workers Retiree Medical Benefits Trust and leads Recovery Audit Contractor (RAC) projects for various states across the country. He has a Bachelor's Degree in Economics from Clemson University and a Masters of Healthcare Administration (MHA) degree from the University of North Carolina at Chapel Hill.

Kevin Carlson

Chief Technology Officer / Health

Kevin Carlson has more than 20 years of experience in the health care technology sector. Mr. Carlson has overseen the development and implementations of numerous electronic health record, revenue cycle management (RCM), business intelligence, and health information exchange (HIX) systems across the United States. For PCG Health, he oversees the health software development team which develops and deploys a wide scope of SaaS applications. Mr. Carlson hold a BS in Computer Science from Northeastern University.

Rick Dwyer

Manager / Health

Mr. Dwyer joined PCG in 1993 and has more than 25 years of experience in financial and operations management in corporate and health care provider environments. He has been actively involved in improving revenue and management operations to optimize program revenues and to bring health care facilities into compliance with federal, state, and other third party requirements. He has also directed numerous planning and evaluating projects involving mental health hospital and community-based programs. Project accomplishments in the financial and operational area include the establishment of initial billing, collection, accounts receivable, and financial reporting capabilities for Inpatient Psychiatric Hospitals, Partial Hospital / Psychiatric Day Treatment programs, Outpatient Clinics, Skilled Nursing Facilities and Medicare Part D in long-term care facilities; the redesign of the Patient Accounting and supportive front-end activities; the redesign and enhancement of Financial Reporting and Information Management activities; assisting health care providers in assessing their level of Medicare and Medicaid compliance and to develop and implement corrective action plans designed to bring identified deficient areas into compliance; development of Compliance Program Infrastructure as outlined in the Office of the Inspector General guidelines; and the creation of appropriate internal controls, quality assurance systems, procedure manuals, and management / operational reports where required to enhance operational effectiveness and overall profitability. Mr. Dwyer also directed the work of clinical consultants on projects such as determining alternative community services based on the individual clinical need assessment of mental health consumers and conducting supply and demand studies for state-wide hospital and community based residential services for mental health programs. Mr. Dwyer earned both a BSBA and MBA from Babson College in Wellesley, Massachusetts

Tom Entrikin

Manager / Health

Mr. Entrikin has 40 years of experience with the Medicaid and Medicare programs. From 1981 to 1992, he was a Medicaid policy specialist with the US Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS), providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; health standards and certification requirements; and Medicaid waiver programs. Since coming to PCG in 1992, Mr. Entrikin has assisted in the design, development and implementation of revenue projects for school-based health services; hospital-based and municipal projects for pregnant women, infants, and children; state services offered through youth services, child welfare, mental health, substance abuse, developmental disabilities, and public health agencies; and reimbursement systems for hospitals, long term care facilities, and home and community-based services waiver programs. He has made presentations on home and community-based services waiver programs at national conferences sponsored by the Robert Wood Johnson Foundation as well as presentations on Medicare/Medicaid claiming and waiver options at the National Association of Reimbursement Officers and the National Association of State Human Services Finance Officers.

Amy Ferraro

Manager / Health, Human Services

Ms. Ferraro has more than 17 years of public sector consulting experience and has worked on a variety of revenue management, revenue optimization, and consulting engagements in more than 25 states. She has led revenue optimization projects in states including Colorado, Louisiana, and Montana. She also manages a project for Rhode Island Department of Children, Youth, and Families (DCYF) and is responsible for overseeing the Title IV-E compliance, revenue maximization, cost allocation, Random Moment Time Study (RMTS), and consulting components of the project. Previously, she assisted with the transition of DCYF children to the Rite Care managed care program and worked with the department to determine how children would receive both medical and behavioral health services. Ms. Ferraro has worked with the Massachusetts Department of Children and Families (DCF) since 1996 and is currently the technical advisor for its cost allocation plan. She has worked on Medicaid revenue maximization, rate setting, and cost allocation plan development projects for the Massachusetts Department of Mental Health since 2000. Ms. Ferraro has led large-scale cost allocation projects in states including Arkansas, Delaware, Kansas, Massachusetts, Michigan, Nevada, Vermont, and Maine. Her cost allocation expertise crosses child welfare, Medicaid, income maintenance, public health, behavioral health, and developmental disabilities programs. Ms. Ferraro has conducted several nationwide training sessions, many on behalf of the National Association of State Human Services Finance Officers (HSFo), in the areas of child welfare financing, Medicaid, and cost allocation. She holds a Master's of Public Administration from the Maxwell School of Citizenship and Public Affairs at Syracuse University and earned a Bachelor of Arts cum laude in Politics at Mount Holyoke College.

Aaron Holman

Associate Manager / Health

Aaron Holman has been working in health policy for the past decade, starting in the United States Senate working in Medicare and Health IT areas for Senator Debbie Stabenow (D-Michigan). Mr. Holman also worked as a lobbyist in Washington focusing on health Information Technology (IT) financing, and standards development. Mr. Holman’s private sector experiences have focused primarily on operations improvements and the development of growth strategies for commercial hospital and insurance companies. Many of his clients represented the largest companies in health care in America, including HCA, United Health, Cigna, and Partners Healthcare. Mr. Holman has also worked with various Medicaid agencies in policy and operational improvement areas across various states including New York, Wisconsin and Michigan. Since 2012, he has focused on Accountable Care Act implementation activities at the state level in Marketplace establishment and regulatory affairs, quality measurement, Medicaid program expansion and consumer engagement and education. Mr. Holman has a Bachelor of Arts from University of Michigan and a Master of Science from Harvard University.

Sean Huse

Manager / Health

Mr. Huse is an experienced health management consultant who focuses on financial management, strategic planning, policy analysis, and management reporting for Medicaid, providers, and payer organizations. He currently serves as the Center of Excellence (COE) lead for PCG's Health Care Reform Services (HCRS) unit. HCRS leads the firm's efforts in Health Delivery System Transformation and Health Marketplace consulting. These projects include payment reform, patient centered medical home and health home program design, health data analytics, dual eligible population management, health exchange development, and system innovation consulting. Mr. Huse received a BA in Economics and Neuroscience & Behavior from Wesleyan University and completed an MBA with a concentration in health care administration at Clark University. He is also a Certified Healthcare Financial Professional (CHFP) with the Healthcare Financial Management Association (HFMA).

Kevin Hutchinson

Manager / Health

Mr. Hutchinson oversees PCG's Program Integrity and Provider Management solutions, advising and aiding Medicaid agencies and managed care plans in compliance, fraud, waste, and abuse. He leads a team that provides an innovative solution to program integrity that is unique in the marketplace. This seamless solution integrates provider enrollment, provider screening, investigations, monitoring, data analytics, prepayment and post payment audits. His team conducts thousands of screenings and investigations each year, resulting in millions of dollars in cost avoidance and identified overpayments. Mr. Hutchinson's consulting services include policy enhancement, business process redesign, and performance management. He leverages his extensive experience in state government, health and human services, technology, and management consulting to serve his clients. Prior to joining PCG, Mr. Hutchinson served in the North Carolina Office of the Governor, working with public policy, budget, and management.

John Shaughnessy

Practice Area Director / Health

John Shaughnessy is Director of PCG's health division. He joined the firm in 1992 and has extensive experience in operations improvement, strategic planning, and revenue maximization consulting for hospitals and other health care providers, child welfare agencies, human services agencies, and educational institution. Mr. Shaughnessy has overseen the development and implementation of federally approved cost reports and cost allocation plans and is an expert in reimbursement strategies involving innovative approaches to rate setting and indirect cost recovery. He was instrumental in working with the Illinois Department of Public Assistance (IDPA) and the Massachusetts Division of Medical Assistance (DMA) to develop Title XIX administrative claiming methodologies for school-based health services. He has also overseen several revenue maximization engagements to recover federal revenues through Title IV-E, Medicaid, TANF, and Medicare, among many other federal sources in West Virginia, Louisiana, Missouri, Colorado, and Mississippi. Mr. Shaughnessy holds a degree in accountancy from Bentley College. He has presented the 'Cost Allocation Plans for Human Service Agencies' curriculum and conducted multiple Medicaid trainings on behalf of the National Association of State Human Services Finance Officers (HSFo).

Matthew Sorrentino

Manager / Health

Mr. Sorrentino oversees statewide financial management contracts in Arizona, Georgia, Kansas, Illinois, Nebraska, North Carolina, Texas, and Wisconsin, primarily helping Medicaid and public health care agencies to maximize resources and meet financial objectives. He has an in depth understanding of Medicaid, CHIP, Medicare, and other publicly funded health care programs and his expertise also includes a particular focus on Medicaid reimbursement within institutional and community based settings. Mr. Sorrentino has assisted Medicaid programs to develop and implement inpatient and outpatient hospital payment methodologies, including performing diagnostic related group (DRG) weight recalibration, implementing new DRG groupers, establishing inpatient and outpatient base rates, calculating upper payment limits, implementing provider assessments, determining disproportionate share hospital payments, and assisting states to implement pay for performance methodologies. Mr. Sorrentino has also led numerous studies and evaluations of Medicaid reimbursement rates for community based services, such as physician services, mental health services, school-based services, substance abuse services, and long term care services.

Marc Staubley

Assistant Practice Area Director / Health

Mr. Staubley leads our revenue cycle unit within PCG's Health division. In this role, he oversees projects which include provider rate setting, cost reporting and cost settlement, third party administration, billing services, cost savings / cost recovery, and other strategic planning initiatives. He is an experienced leader with more than 18 years of service to public programs across the country. Mr. Staubley has practical experience in the all areas of state and local finance, specifically in the areas of implementation of federal regulations and third party reimbursement including Medicare, Medicaid and private health insurance. He is a proven project manager heading diverse and complex projects ranging from statewide strategic planning initiatives to technical efforts in the design and development of provider rates. In addition, he oversees numerous billing and claim adjudication projects, including third party billing operations, payment processing and reconciliation and cost settlement initiatives. Mr. Staubley currently serves as PCG's cost accounting expert, managing the development and submission of hundreds of annual federal cost reports for public service providers.

Jim Waldinger

Manager / Health

Mr. Waldinger focuses on health care reform, Medicaid policy, analysis and implementation. His specific areas of focus are health care reform and its impact on the Medicaid program and the behavioral health system. Prior to joining PCG, Mr. Waldinger served as CFO and Budget Director for the Massachusetts Medicaid program, MassHealth, and more recently as the CFO for the Massachusetts Behavioral Health Partnership, which managed the behavioral health needs of more than 300,000 Medicaid members. While at MassHealth, Mr. Waldinger focused on calculating and tracking hospital payment mechanisms, including Upper Payment Limit (UPL), Disproportionate Share Hospital (DSH), and other supplemental payments. He also served as MassHealth's lead finance analyst during the creation of Massachusetts's landmark health care reform legislation. He created the financial documents used in submission of Health Care Reform 1115 waiver to the Centers for Medicare and Medicaid Services (CMS). As CFO for the Massachusetts Behavioral Health Partnership (MBHP) – the state's behavioral health carve-out vendor – Mr. Waldinger re-vamped the organization's cost projection methodologies and calculated and implemented aggressive inpatient pay-for-performance measures.